The purpose of this application is to re-examine a large population- based cohort to determine the 5-year incidence and progression of hearing loss and the risk factors for each outcome. Participants (n=3753) in Beaver Dam, WI, were ages 48-92 years at baseline. The re- examinations will be conducted, using the same standardized protocols for otoscopy, screen tympanometry, pure tone audiometry, word recognition tests and distortion product otacoustic emissions. A standardized questionnaire about medical history, noise exposure, and the functional impact of hearing impairment will be administered. New protocols will build upon cross-sectional results which suggested that atherosclerosis, exposure to tobacco smoke and familial factors may be associated with hearing loss. B-mode carotid ultrasound will be used to obtain an objective marker of generalized atherosclerosis. Serum cotinine, an objective measure of exposure to tobacco smoke will be measured. Using extensive pedigree and genetic marker information obtained in the Beaver Dam Linkage Studies of Age-Related Ocular Disorders, segregation analyses and preliminary linkage studies will be performed to elucidate genetic factors for hearing loss. The prevalence of olfactory deficits will be measured using an odor identification test. Data on vision, ocular disorders and physical functioning will be available from the planned ten-year follow-up of the Beaver Dam Eye Study. A 7-year follow-up telephone interview will be used to assess prospective relations between multiple sensory deficits and function. The study is intended to provide new data about the risks of incidence and progression of hearing loss in older adults and potentially modifiable factors associated with incidence and progress of hearing loss. It will provided much-needed, population-based data on the prevalence and risk factors for olfactory deficits.